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Snapshots of Doctoral Research
at University College Cork 2014
Bundle of Joy: Improving Prenatal
Well-being with Gratitude and Mindfulness
Karen O’ Leary
School of Applied Psychology, UCC
Feeling the weight
Your feet, hands and belly are swollen. Your back is sore and there is almost constant
pressure on your bladder. At times you feel absolutely exhausted. That’s right, you’re
pregnant. Your body is doing amazing things; your baby is growing and wriggling about.
You are filled with a new sense of expectancy and love, but you have also realised some-
thing. Pregnancy is not quite the 9 months of joy and wonder you thought it would be.
You can deal with the physical complaints because you believe that they happen to every-
one. The stress and sadness you are feeling is quite another thing. At times you feel like
crying or giving up. There are many possible reasons for this. Maybe it is because your life
has changed more than you are comfortable with. You may receive little or no help and
support from your family, or your partner shows little interest in the pregnancy. Work may
feel more stressful. You are worried about the future, the birth, your finances, or your life.
Maybe for any or for all of these reasons, life has lost some of its colour and joy. You think
to yourself, “that’s not meant to happen when I’m pregnant, is it?”
For many women, low levels of well-being, characterised by stress, anxiety and unhap-
piness, are common and pervasive in pregnancy. Well-being involves being healthy and
happy; it involves mental and physical aspects. Low levels of well-being are problematic
for the expectant mother because they increase her risk of depression and engaging in
an unhealthy behaviour, such as smoking. There are also subsequent effects for the de-
veloping foetus. For example, low maternal well-being during pregnancy can result in
pregnancy complications, low birth weight, and premature birth. These birth outcomes
can subsequently impact on infant and child development; so low prenatal well-being goes
beyond simply feeling ‘a bit down’, and can have serious consequences. In Ireland, our
maternity services provide high levels of prenatal care to approximately 70,000 expectant
mothers each year. These services mainly monitor and foster the mother and baby’s phys-
ical health and well-being but there is very little focus on fostering and promoting mental
health during pregnancy. So, what can you do? How can you maintain or increase your
well-being while you’re pregnant?
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Bundle of Joy: Improving Prenatal Well-being with Gratitude and
Mindfulness
KAR EN O’ LE ARY
Improving Well-being
As a pregnant woman you can engage in activities to improve your well-being. You can
do pregnancy yoga, pregnancy pilates or go for an “expectant mother” spa package. Yes,
these activities can boost your mood, but are these activities really that accessible to most
women? Firstly they all cost money. A 6 week pregnancy yoga class in Cork city costs C70,
while a pregnancy spa package can set you back C155. What if you cannot afford this or
you can only afford it once in the 9 months of pregnancy? What if you can afford it but
just don’t have the time to go? As a working, pregnant mother who already has a toddler
running around, being able to go to the local yoga class is not exactly feasible.
This is where my research in health and positive psychology comes in. Health psychology
has a long established tradition of examining changes and differences in health and well-
being. In this case, my health focus is in the context of pregnancy. Positive psychology is
the study of factors that allow us to thrive and live meaningful lives. It is not a happyology,
as sometimes suggested, with a lot of pop psychologists running around telling everyone
to ‘smile more, it will make you feel better’. It is a scientific approach, which adopts a
positive view of human functioning. The idea that we can foster and improve people’s
lives, rather than only supporting people in difficulty, is core in positive psychology. This
counters the traditional view of pregnancy as a period of vulnerability where women may
experience stress or depression and need treatment. A number of positive psychological
interventions or exercises have been developed to improve well-being. The two types
of interventions I use in my research are based on the positive constructs of gratitude
and mindfulness. These constructs have a long history in people’s private practice and in
research.
Feeling Grateful, Feeling Mindful
Gratitude involves an appreciation of the positive in life. It can involve anything from a
delicious home cooked meal to receiving a favour from a friend. The most widely studied
gratitude-based intervention is the gratitude diary; this is sometimes referred to as ‘count-
ing your blessings’. In this exercise people are asked to think back over their day and write
down things they feel grateful for. The main requirement is that they truly feel grateful for
what they write down.
Mindfulness involves being fully aware of your thoughts, feelings and sensations in the
present moment, in a non-judgmental way. In a sense, all internal and external stimuli are
acknowledged but are not judged as positive or negative, they are simply accepted. This
is not always an easy thing to do and mindfulness is a skill that must be practiced. Mind-
fulness has its roots in the Buddhist tradition. It shares a focus with positive psychology
on cultivating positive aspects within oneself to bring about greater well-being.
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KAR EN O’ LE ARY Bundle of Joy: Improving Prenatal Well-being with Gratitude and
Mindfulness
Studies examining both gratitude and mindfulness interventions have consistently demon-
strated benefits for well-being. Both types of intervention can reduce stress, anxiety, de-
pression and physical symptoms. They can also increase happiness, life satisfaction and
physical health. Strangely, despite how much we know about the benefits of gratitude and
mindfulness for physical and mental health, their usefulness has yet to be fully examined
during pregnancy. As we noted earlier, improvements in well-being would benefit both
the mother and child during pregnancy. So we need to find short, easy and cost-effective
interventions that are readily accessible to all pregnant women. We then need to prove
that they work! My research is focused on these two challenges.
My Research
My research involves two main studies to develop and test the usefulness of gratitude
and mindfulness exercises during pregnancy. In the first study I developed two new inter-
ventions, one based on mindfulness and one based on gratitude. The gratitude exercise
involves writing and thinking about things that you are grateful for. The mindfulness ex-
ercise focuses on writing and thinking about your thoughts, feelings and sensations in the
present moment. An important part of this mindfulness exercise is that you are thinking
but not dwelling or judging anything you think or feel. Both of these exercises can be
completed at home in 15 minutes. In the first study non-pregnant women used the inter-
ventions 3 to 4 times a week, for 1 month. The women were randomly assigned to one of
the intervention groups or a control group. The control group did not do the gratitude or
mindfulness exercises during the study. The aim was to see which intervention was most
effective before using it with the pregnant group. From this study, I found that combining
elements of both exercises has the greatest potential to improve well-being.
The second study examines the effect of a new intervention on prenatal well-being. This
exercise combines aspects of both gratitude and mindfulness. The impact of the exercise
on well-being is examined in comparison to standard prenatal care. Although not yet
completed, provisional results suggest that this 15-minute exercise can reduce levels of
stress, depression and improve happiness and life satisfaction among pregnant women.
This indicates that the exercise has the potential to provide a quick, easy and cost-effective
way to maintain and enhance well-being during pregnancy. As there are currently no
programs or interventions in place to promote mental well-being during pregnancy this
could be especially beneficial for expectant mothers and their developing babies.
I would like to thank my supervisor Dr Samantha Dockray, School of Applied Psychology, for
her support and advice, and also The O’Connor Scholarship for funding received. I would
also like to thank Dr Mairead O’ Riordan, Professor Louise Kenny and Professor John Higgins,
Department of Obstetrics and Gynaecology, for support provided in conducting this research.
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